When he played at Lawrence High in the 1970s, Bob Lisher remembers many times that his head would bang against the top of his helmet.

“Back then, the equipment is so different, there’s not too many days you didn’t come out of practice with a headache or dizziness or seeing stars,” said Lisher, Free State High’s 15th-year football coach.

A lot has changed since then. Players are no longer encouraged to ignore symptoms like the ones Lisher described — all possible signs of a concussion.

Increased awareness about the potentially harmful effects of head injuries has led to additional safety precautions.

Her SCAT2 is a pocket-sized, two-sided questionnaire that tests an athlete’s cognitive function, memory, balance and coordination to see if signs of a concussion are present.

With the SCAT2, she asks the athlete basic questions. That could include what the score is or where the person is right now.

She’s also asking questions to see if any other concussion symptoms are present, such as ringing in the ears, headaches or dizziness.

If the athlete exhibits any of the symptoms after a blow to the head, he comes out of the game and is not allowed to return — a decision that is out of the coach’s jurisdiction.

Following a concussion diagnosis, Free State follows the School Sports Head Injury Prevention Act that was enacted by the Kansas Legislature and put into effect on July 1. The athlete cannot come back to competition without getting a signed form by a physician.

If a football player has the signed form, Johnson Manternach starts him on a graded return.

The first day, she will run him through light cardio, like jogging the sideline for 15 minutes, then will check to see if any of the concussion symptoms reappear. If they do, the athlete is shut down, and the process is restarted after a 24-hour period.

If there are no problems following the light jog, the athlete goes through a tougher workout the next day to see if the symptoms return.

It typically takes about seven to 10 days before the athlete makes it back to full game play, assuming he shows no lingering effects following the concussion.

The School Sports Head Injury Prevention Act also requires that athletes and their parents sign a concussion and head injury release form each school year.

Hidden numbers

Lisher and Lawrence High football coach Dirk Wedd said their programs average around two to four diagnosed concussions per year.

Johnson Manternach fears that the number of undiagnosed concussions is much higher.

“We’re trying so hard to get away from that thinking that it’s just no big deal,” Johnson Manternach said. “But (athletes) also know that, ‘If I tell someone, I’m probably going to have to sit out, but this is Olathe North, and I really don’t want to sit out.’

Recent studies also have suggested that the damage from concussions might not be observable until years later.

Dr. Ann McKee, a researcher at Boston University, studied the brains of 12 former football players in 2008 and in each found the presence of an abnormal protein called tau — a signal of the degeneration of brain tissue.

Tau protein leads to Chronic Traumatic Encephalopathy (CTE) — a degenerative disease that can appear years or decades after a person’s last concussion.

One of McKee’s subjects was an 18-year-old high school football player who’d had multiple concussions, and a sample of brain tissue showed tau protein and early evidence of CTE.

“Once that brain has deteriorated, once that damage has been done, you can’t fix it,” Johnson Manternach said. “It doesn’t grow back. It’s not like ... your ankle you can rehab or a knee that gets replaced. Once those cells are dead, they’re dead.”

Even the best helmets can’t prevent some concussions, meaning unless there are major rule changes one day, football players will participate knowing they are taking on some risk.

Johnson Manternach said one of the biggest obstacles that remains is convincing athletes that concussions should be taken seriously.

“I love football season,” she said, “but I also want these kids to be functional adults.”